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Example Change Control Package
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Configuration Management - index
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Example Change Control Package cont'd - doe-std-1073-20030103


DOE-STD-1073-2003
Configuration Management
10.
Affected SSCs: (List the SSCs affected by the proposed change. Identify their classification
levels. Reference their documented design requirements. See item 3 above for classification
levels. Use continuation sheets as necessary)__________________________________________
______________________________________________________________________________
11.
Are there design changes associated with the proposed change?
[ ] yes [ ]no
If yes, complete item 12.
12.
Design review complete and attached or referenced: [Verifies that all SSCs involved in or
affected by the change have been identified (and properly classified where appropriate), that the
requirements for SSCs have been documented, that appropriate reference documents are listed, and the
design criteria are listed.]
[ ] yes
13.
Independent verification complete?
[ ] yes
14.
Interdisciplinary review of proposed change complete?
[ ] yes
15.
Will the change significantly degrade safety or negatively impact adequate protection of
workers, the environment, or the public? [ ] no  [ ] yes, and proposed change is rejected.
16.
Identify the requirements and standards that apply to the change. (attach list)
Management Review
17.
Was the technical review adequately performed? (adequately performed according to review
procedures)
[ ] yes
[ ]no, return for completion
18.
The work control package is complete, ready for implementation, and attached?
[ ] yes
19.
The necessary approvals have been obtained and are attached.
[ ] yes
20.
Identify the source(s) of funding to implement the change and update the documentation.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
21.
Is the change necessary, and if so, why?
_______________________________________________________________________________
_______________________________________________________________________________
22.
Do the benefits of the change warrant the costs?
[ ] yes
USQ Review Questions
23.
Is a USQ review required for the proposed change?
[ ] yes [ ] no
24.
If yes, has the USQ review been completed?
[ ] yes
F-3


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